Provider Demographics
NPI:1609051796
Name:MICHAEL D. HALL DPM PA
Entity Type:Organization
Organization Name:MICHAEL D. HALL DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-341-4306
Mailing Address - Street 1:2901 CORAL HILLS DR STE 330
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4165
Mailing Address - Country:US
Mailing Address - Phone:954-341-4306
Mailing Address - Fax:
Practice Address - Street 1:2901 CORAL HILLS DR STE 330
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4165
Practice Address - Country:US
Practice Address - Phone:954-341-4306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOOOO1300332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0538880001Medicare NSC